Institute of Biomedical Systems, National Research University of Electronic Technology, Zelenograd, Russian Federation.
Institute for Bionic Technologies and Engineering, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
Comput Methods Biomech Biomed Engin. 2021 May;24(6):653-662. doi: 10.1080/10255842.2020.1843640. Epub 2021 Jan 11.
The decompensated univentricular circulation is identified as one of the most challenging conditions and the application of the mechanical circulatory support (MCS) devices is proposed as therapeutic option for Fontan failure. Modelling methodologies are reported to identify the optimized types, extent and duration of required hemodynamic support using MCS. The specific parameters of device-body interaction during support of failing Fontan circulation within the design points of dedicated pediatric ventricular assist devices has not been previously defined. In this work, we introduce a mathematical model developed to simulate the interaction between the Fontan single-ventricular circulation and a constant-flow pediatric ventricular assist device (VAD) Sputnik. The interaction is studied at a pump rotor speed of 5000-9000 rpm. This simulation demonstrates that the pump replacing pulmonary ventricle of the heart creates necessary pressure differential between the systemic veins (7 mmHg) and the pulmonary artery (17.3 mmHg). Moreover, it increases the venous return that, according to the Frank-Starling mechanism, increases the stroke volume up to 32 ml/bpm (26 ml/bpm - without using a pump). For the first time, a simulation for the pediatric VAD Sputnik has been carried out. The simulation results confirm pediatric VAD Sputnik can be a possible tool to normalize the Fontan circulation in pediatric patients.
代偿失调的单心室循环被认为是最具挑战性的情况之一，机械循环支持（MCS）设备的应用被提议作为 Fontan 衰竭的治疗选择。已经报道了建模方法，以使用 MCS 确定优化的 MCS 类型、程度和持续时间，以提供所需的血液动力学支持。在专用儿科心室辅助设备的设计点内，支持衰竭的 Fontan 循环期间，设备-主体相互作用的具体参数以前没有定义。在这项工作中，我们引入了一个数学模型，该模型旨在模拟 Fontan 单心室循环与恒定流量儿科心室辅助设备（VAD）Sputnik 之间的相互作用。在 5000-9000rpm 的泵转子速度下研究了这种相互作用。该模拟表明，泵替代心脏的肺动脉会在体循环静脉（7mmHg）和肺动脉（17.3mmHg）之间产生必要的压差。此外，它增加了静脉回流，根据 Frank-Starling 机制，将每搏量增加到 32ml/bpm（不使用泵时为 26ml/bpm）。首次对儿科 VAD Sputnik 进行了模拟。模拟结果证实，儿科 VAD Sputnik 可以成为一种使儿科患者的 Fontan 循环正常化的可能工具。
